超滤技术对体外循环心脏瓣膜置换术肺损伤保护的研究

The Effects of Ultra-filtration Technique on Pulmonary Function during Heart Valvular Replacement under Extracorporeal Circulation

目的:探讨在体外循环心脏瓣膜置换术后肺损伤作用机制及改良超滤联合平衡超滤技术对体外循环肺功能的保护效果。方法:择期行心脏瓣膜置换术患者60例,分为对照组(C)、常规超滤组(D1)、改良超滤联合平衡超滤组(D2)。分别在麻醉后转流前(T1),转流结束时(T2),术后2 h(T3),术后6 h(T4),术后12 h(T5)采集动脉血,应用双抗体夹心ELISA法测定血浆内皮素-1(EF-1)、肿瘤坏死因子-α(TNF-α)、白介素6(IL-6),测定结果用Hct值校正,记录各组体外循环后超滤前、超滤后Hct值和计算肺泡氧合指数(OI)、肺泡-动脉血氧分压差(P(A-a)O2)、肺顺应性(Cstat)。结果:D1、D2组在T2、T3、T4、T5时点OI显著高于对照组C(P<0.05);D2组P(A-a)O2在T3、T4、T5时点较D1组、C组低(P<0.05),D2组Cstat明显高于D1、C组;超滤后超滤组(D1、D2)Hct值较对照组显著增高(P<0.05);D2组EF-1、TNF-α和IL-6浓度在T2、T3、T4、T5时点较D1组、C组明显降低(P<0.05)。结论:复合超滤较单一超滤方法能较好地改善瓣膜置换术患者术后肺功能,降低体内EF-1及炎性介质浓度。

Objective：To investigate the effect of using modified ultrafihration and balanced ultrafiltration on postoperative pulmonary function of patients with cardiac valvular replacement under extracorporeal circulation. Method：60 cases with heart valvular replacement were randomly divided into the control group（C）,conventional ultrafiltration group （D1）and balanced ultrafiltration with modified ultrafiltration group（D2）.The hematocrit（Hct）, pulmonary function（OI、Cstat and P（A-a）O2）,and the concentrations of tumor necrosis factor-α（TNF-α）Endothelin-1（EF-1） and interleukin-6（IL-6）in the three groups were respectively monitored at specific time points.Result：In group （D1,D2） at T2,T3,T4 and T5 point OI was significantly higher than that in control group C （P〈0.05）.In group D2 P（A-a）O2 at T3, T4 and T5 point was lower than in group （D1,C）（P〈0.05）.Cstat in group D2 was obviously higher than that of group（D1、C）.Hct of ultrafiltration in group（D1,D2） was significantly higher than that in the control group C（P〈0.05）.The concentration of EF-1,TNF alpha and IL-6 in group D2 at T2,T3, T4,T5 point was lower significantly than the group（D1,C）（P〈0.05）.Conclusion：Composite ultrafiltration can well improve the postoperative pulmonary function in patients with valvular replacement, reduced the concentration of EF-1 and inflammatory medium in the body.